Provider Demographics
NPI:1932487998
Name:BINVERSIE, TESSA LEA (DC)
Entity Type:Individual
Prefix:DR
First Name:TESSA
Middle Name:LEA
Last Name:BINVERSIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LEIGH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-2236
Mailing Address - Country:US
Mailing Address - Phone:270-557-8388
Mailing Address - Fax:
Practice Address - Street 1:125 LEIGH AVE STE B
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-2236
Practice Address - Country:US
Practice Address - Phone:270-557-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011983111N00000X
IL038.011983111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor